Stereotactic and ultrasound core needle breast biopsy performed by surgeons

doi:10.1016/S0002-9610(97)00199-2

The American Journal of Surgery

Volume 174, Issue 6, December 1997, Pages 699-704

https://doi.org/10.1016/S0002-9610(97)00199-2 Get rights and content

Background

The authors evaluated outcomes and treatment costs of stereotactic core needle biopsy (SCNB) and ultrasound core needle biopsy (UCNB), and needle localization biopsy (NLB) in managing patients with mammographic abnormalities presenting to the surgeon.

Methods

Data for all patients with mammographic lesions who underwent SCNB or UCNB since their introduction at this institution were prospectively collected over 17 months. Mean inclusive costs of the three procedures were accumulated and compared.

Results

Stereotactic core needle biopsy was performed for 342 lesions in 319 women, for a malignancy rate of 19%; UCNB was performed for 157 lesions in 144 patients, yielding a malignancy rate of 17%. With a mean follow-up of 13.5 months, 1 patient with in situ carcinoma was diagnosed late. Absolute cost savings for the period studied was $721,963.

Conclusions

Minimally invasive breast biopsy procedures can safely and reliably be performed by surgeons in clinical practice with increased patient convenience and decreased costs.

References (25)

BurnsRP
Image guided breast biopsy
Am J Surg
(1997)
JanesRH et al.
Initial 300 consecutive stereotactic core-needle breast biopsies by a surgical group
Am J Surg
(1994)
AzavedoE et al.
Stereotactic fine-needle biopsy in 2,594 mammographically detected non-palpable lesions
Lancet
(1989)
SchmidtRA
Stereotactic breast biopsy
CA Cancer J Clin
(1994)
IsraelPZ et al.
Stereotactic needle biopsy for occult breast lesions: a minimally invasive alternative
Am Surg
(1996)
RoeSM et al.
Bringing core biopsy into a surgical practice
Am Surg
(1996)
StarenED
Surgical office-based ultrasound of the breast
Am Surg
(1996)
SailorsDM et al.
Needle localization for nonpalpable breast lesions
Am Surg
(1994)
YimJH et al.
Mammographically detected breast cancer: benefits of stereotactic core versus wire localization biopsy
Ann Surg
(1996)
ParkerSH et al.
Percutaneous large-core breast biopsy: a multi-institutional study
Radiology
(1994)

GisvoldJJ et al.

Breast biopsy: a comparative study of stereotaxically guided core and excisional techniques

Am J Roent

(1994)

JackmanRJ et al.

Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia

Radiology

(1994)

Cited by (25)

Asymptomatic Complicated Cysts in Postmenopausal Women: Is Tissue Sampling Unnecessarily High?
2019, Academic Radiology
Citation Excerpt :
Lesions lacking through transmission were usually located in the posterior depth (Fig 3) although posterior enhancement in a separate study was found to a variable degree even in simple cysts (20). Older studies suggest that FNA can readily confirm the cystic nature of a lesion and therefore recommend its routine use for all lesions described as indeterminate (7,21). Given such a low malignant potential not only in our cohort, but in other studies, these small indeterminate lesions without suspicious mammographic correlate can safely be managed with short-term follow-up and unnecessary procedures can be avoided (7,18,22).
To determine the malignancy rate of complicated cysts in postmenopausal women and to discuss appropriate (Breast Imaging Reporting and Data System assessment and recommendation.
This study was approved by our institutional review board and informed consent was waived. One hundred fourteen postmenopausal patients with 183 complicated cysts as defined by the newest Breast Imaging Reporting and Data System edition were identified retrospectively between January 2013 and December 2015 (to allow for 2 years follow-up period). One hundred eight complicated cysts were assessed as probably benign and 75 as suspicious. Prospective review of all images and pathology was performed and patient's age, breast density, risk factors, use of hormone replacement therapy, and family history of breast cancer were recorded. A total of 30 symptomatic patients and lesions not meeting criteria for complicated cysts were excluded from our cohort. Benignity was determined by aspiration, biopsy, resolution, recategorization to a simple cyst, or adequate follow-up.
None of our complicated cysts proved malignant. Fifteen of 108 probably benign complicated cysts were aspirated yielding benign fluid in 10 and 5 were biopsied yielding benign pathology (only 2 with atypical cells). Twenty-nine of 75 complicated cysts categorized as suspicious were aspirated and fluid was discarded in 25 and 4 sent for cytology yielding benign pathology. The other 41 complicated cysts thought to be suspicious were biopsied with benign pathology (only 1 atypical).
This study supports the use of a probably benign assessment of asymptomatic complicated cysts irrespective of age. The sensitivity for malignancy was 100% in our cohort.
Ultrasound Imaging Technologies for Breast Cancer Detection and Management: A Review
2018, Ultrasound in Medicine and Biology
Citation Excerpt :
Image-guided breast biopsy is currently the gold standard for the pathologic evaluation of breast cancer. It can be performed safely and reliably with minimal invasiveness in clinical practice and with increased patient convenience and decreased cost (Roe et al. 1997). Ultrasound, stereotactic mammography, MRI and positron emission mammography (PEM) are now successfully used to guide the biopsy needle to obtain a proper tissue sample that can be histologically assessed.
Ultrasound imaging is a commonly used modality for breast cancer detection and diagnosis. In this review, we summarize ultrasound imaging technologies and their clinical applications for the management of breast cancer patients. The technologies include ultrasound elastography, contrast-enhanced ultrasound, 3-D ultrasound, automatic breast ultrasound and computer-aided detection of breast ultrasound. We summarize the study results seen in the literature and discuss their future directions. We also provide a review of ultrasound-guided, breast biopsy and the fusion of ultrasound with other imaging modalities, especially magnetic resonance imaging (MRI). For comparison, we also discuss the diagnostic performance of mammography, MRI, positron emission tomography and computed tomography for breast cancer diagnosis at the end of this review. New ultrasound imaging techniques, ultrasound-guided biopsy and the fusion of ultrasound with other modalities provide important tools for the management of breast patients.
Management of nonpalpable ultrasound-indeterminate breast lesions
2003, Surgery
A series of such lesions was studied to determine the validity of applying criteria routinely used to manage palpable breast cysts to the management of mammographically detected, nonpalpable breast lesions characterized as indeterminate on ultrasound (US).
The clinicopathologic data from a series of 134 patients who underwent US-guided fine needle aspiration biopsy for nonpalpable, mammographically detected breast lesions, categorized as indeterminate on US, were reviewed.
Of 139 indeterminate lesions, 78 were consistent with complex cysts, whereas in 61, the cystic-versus-solid nature was indistinguishable. All 71 complex cyst lesions that contained nonbloody fluid and resolved completely were benign. Two of 7 complex cyst lesions that had incomplete resolution, bloody aspirate, or both were malignant. Of 61 cystic-versus-solid lesions, 29 and 32 were primarily solid and cystic, respectively. Three of the 29 solid lesions were malignant. Of the 32 cystic lesions, all 26 that contained nonbloody fluid and resolved completely were benign, whereas 1 of 6 lesions that had incomplete resolution, bloody aspirate, or both was malignant.
Criteria such as complete resolution and nonbloody aspirate are an effective adjunct to the management of nonpalpable, mammographically detected breast lesions categorized as indeterminate by US.
Comparison of core needle breast biopsy techniques: Freehand versus three-dimensional US guidance
2002, Academic Radiology
No single method is generally accepted for evaluating the accuracy of breast biopsy techniques before their clinical implementation. The purpose of this study was to test a new process for evaluating biopsy techniques by using it in the evaluation of a prototype three-dimensional ultrasound (US)–guided biopsy device.
The biopsy accuracy of a new three-dimensional US–guided breast biopsy device was compared to that of the accepted clinical practice of biopsy by expert radiologists with two-dimensional freehand US guidance. Biopsies were performed in chicken tissue phantoms containing 3.2-mm lesions made of poly(vinyl alcohol) cryogel. The criterion for a successful biopsy was the presence of lesion in the sample. The equivalence limit difference tested was 10% by using a power of 90% and a two-sided test significance level, α, of 10%.
The biopsy success rate of the three-dimensional US–guided system (96%) was equivalent to that of expert radiologists using two-dimensional freehand US guidance (94.5%) in tissue phantoms containing poly(vinyl alcohol) cryogel lesions.
This evaluation procedure is a valuable precursor to clinical trials in the assessment of biopsy techniques. The three-dimensional US–guided breast biopsy system provides a suitable alternative to two-dimensional freehand US guidance for biopsy of breast cancer.
Three-dimensional ultrasound-guided core needle breast biopsy
2001, Ultrasound in Medicine and Biology
A new core needle breast biopsy system guided by 3-D ultrasound (US) is proposed. Our device provides rapid imaging and real-time guidance, as well as breast stabilization and a needle guidance apparatus using 3-D imaging. The targeting accuracy of our device was tested by inserting a 14-gauge biopsy needle into agar phantoms under 3-D US guidance. A total of 18 0.8-mm stainless-steel beads embedded in the phantoms defined each of the four target positions tested. Positioning accuracy was calculated by comparing needle tip position to the preinsertion bead position, as measured by three observers three times each on 3-D US. The interobserver standard error of measurement was no more than 0.14 mm for the beads and 0.27 mm for the needle tips. A 3-D principal component analysis was performed to obtain the population distribution of needle tip position relative to the target beads for the four target positions. The 3-D 95% confidence intervals were found to have total widths ranging from 0.43 to 1.71 mm, depending on direction and bead position. (E-mail:[email protected])
An introduction to economic issues in breast imaging
2000, Radiologic Clinics of North America
Citation Excerpt :
Lind et al33 report that patients who underwent stereotactic core biopsy had reduced total charges per cancer patient compared with needle-localized surgery cancer patients ($11,700 versus $15,654). Other studies have confirmed these findings.42,56 According to Lee et al,28 cost savings of stereotactic core procedures vary in subgroups of patients, depending on the mammographic findings.
Mammography facilities face significant economic challenges in today's health care market. In an era of decreasing reimbursement, increasing patient demands, and strict federal regulations, it is difficult for many breast imaging centers to provide high-quality services without accepting a financial loss. For radiologists and administrators, understanding breast imaging economic issues is critical. This article discusses some of the economic factors that shape the practice of mammography in the United States, including Medicare reimbursement, the role of new technology, the cost-effectiveness of screening mammography, and current economic challenges. A glossary of relevant economic terms is included at the end of this article.

View all citing articles on Scopus

^**: Presented at the 49th Annual Meeting of the Southwestern Surgical Congress, Rancho Mirage, California, April 13–16, 1997.

View full text

Stereotactic and ultrasound core needle breast biopsy performed by surgeons**

Background

Methods

Results

Conclusions

Am J Surg

Am J Surg

Lancet

Stereotactic breast biopsy

CA Cancer J Clin

Stereotactic needle biopsy for occult breast lesions: a minimally invasive alternative

Am Surg

Bringing core biopsy into a surgical practice

Am Surg

Surgical office-based ultrasound of the breast

Am Surg

Needle localization for nonpalpable breast lesions

Am Surg

Mammographically detected breast cancer: benefits of stereotactic core versus wire localization biopsy

Ann Surg

Percutaneous large-core breast biopsy: a multi-institutional study

Radiology

Breast biopsy: a comparative study of stereotaxically guided core and excisional techniques

Am J Roent

Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia

Radiology